- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.30 / $220.19 / $252.90
| Professional | | $162.30 | $220.19 | $252.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.07 / $271.07 / $287.54
| Professional | | $271.07 | $271.07 | $287.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.50 / $315.30 / $332.32
| Professional | | $234.50 | $315.30 | $332.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.98 / $199.98 / $199.98
| Professional | | $199.98 | $199.98 | $199.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.48 / $248.36 / $1,548.19
| Professional | | $211.48 | $248.36 | $1,548.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.32 / $244.43 / $371.52
| Professional | | $205.32 | $244.43 | $371.52 |